College-Promise-Application-for-12th-Cohort

Montgomery County Ohio College Promise Program Application Directions Due November 15, 2021 Please keep directions for your records.. M ONTGOMERY C OUNTY O HIO C OLLEGE P ROMISE A

Montgomery County Ohio College Promise

Program Application Directions

Due November 15, 2021

Please keep directions for your records

M ONTGOMERY C OUNTY O HIO C OLLEGE P ROMISE A PPLICANTS M UST :

 Be currently enrolled in school as an eighth grader and plan to attend a high school in Montgomery County

 Demonstrate a financial need

 Attend school regularly

 Have earned satisfactory grades

 Be committed to doing their best

M ONTGOMERY C OUNTY O HIO C OLLEGE P ROMISE S CHOLARS M UST :

 Come prepared to their weekly meetings with an assigned mentor

 Maintain good grades and a strong record of school attendance

 Stay Alcohol, Tobacco, Drug, and Crime Free

 Participate in school co-curricular or extra-curricular activities and/or

community/faith based service activities

 Attend any at-large programs or activities sponsored by the Montgomery County Ohio College Promise program

 Practice Good Citizenship

 Maintain a financial need

 Attain a High School Diploma with a grade point average (GPA) and test scores high enough to meet the entrance requirements of Central State

University, Denison University, Kettering College, Miami University,

Miami University Regionals, Ohio Northern University, Ohio University, Sinclair College, University of Dayton, Wittenberg University, Wright State

University, Xavier University, or other 4-year university partners

M C O C P S R :

A Mentor

An Adult Mentor will be assigned to each scholar Mentors will assist and

encourage the scholar to reach their full potential The mentor and the scholar will meet weekly during the school day at the scholar’s school

A Scholarship

A scholarship to attend one of Montgomery County Ohio College Promise’s 12 college and university partners at little-to-no cost Each student has the

opportunity to earn a bachelor’s degree through this scholarship opportunity

Certain partner schools offer scholarships on a limited basis, but every student has

a scholarship pathway available to them Students and college/university partners begin finalizing decisions about college choice during the student’s senior year of high school

D IRECTIONS :

All sections of the application must be completed and postmarked by November

15, 2021 Applications and attachments must be mailed or hand delivered (only

the recommendation pages can be emailed) Mail or hand deliver the completed applications and all attachments to:

Montgomery County Ohio College Promise

1401 S Main Street, Suite 100 Dayton, Ohio 45409

Students who are selected as finalists and their parent(s)/guardian(s) will be

required to attend an interview with the selection committee in January

Please call the Montgomery County Ohio College Promise office at 937-225-9957

if you have any questions

You can also visit www.mcocp.org or e-mail jguanciale@mcocp.org for more information

*This information included in this application is for MCOCP office use only and will not be shared with any third-party.*

To be eligible for the College Promise Scholarship you household income must fall below the amounts shown on the following chart:

Household

Size Annual Monthly

Twice per Month

Every Two Weeks Weekly

*Income Eligibility Guidelines Provided by the United States Department of

Agriculture Food and Nutrition Service

Please review each section and ensure you have attached all the necessary documentation before mailing in your application Late or incomplete applications will not be

considered

 Section 1: Student Information (p 1)

 Section 2: Parent/Guardian Information (p.10)

o 6 th and 7 th Grade Report Cards (grades and attendance records)

o 5 th , 6 th , and 7 th AIR Testing Results

o Achievement and Ability test results (if available)

 Responsibilities Contracts

o Signed Student Responsibilities Contract

o Signed Parents/Guardians Responsibilities Contract

 Letters of Recommendation

o Teacher Recommendation Form

o Additional Recommendation Form

 Employment Verification

(If a one parent/guardian household, only attach one form)

o Employment Verification Form (parent/guardian 1)

o Employment Verification Form (parent/guardian 2)

 Income Information

Attach to your application all of the following to establish proof of income for

everyone in your household over the age of 18:

o A copy of all 2020 Federal Income Tax Returns filed by any members of your household

o Proof of SNAP (food stamp) eligibility for anyone in your household

o Child Support Statements for anyone in your household

o Proof of eligibility for TANF Funds for anyone in your household

o Unemployment Benefits Statements for anyone in your household

o Proof of Disability or Survivor Benefits for anyone in your household

o Any other items which can be used to verify your household’s income

Montgomery County Ohio College Promise

Program Application

Name: _

Current School of Attendance:

Guidance Counselor Name: _

Guidance Counselor Phone:

Guidance Counselor Email: _

Date Submitted: / /

S ECTION 1: S TUDENT I NFORMATION

Personal Information

Student Name: _

Date of Birth _/ _/ Gender:  Male  Female  N/A Address Apartment # _

Home/Cell Phone #: _

Are you a U.S Citizen? Yes  No What is your race?

Is English your first language? Yes  No If not, what is? _

Do you speak any other languages? Yes  No

If yes, what other languages?

If selected for an interview, will you/parent/guardian need a translator? Yes  No

If yes, what language? _

Have you ever been suspended (in school or out of school) or expelled from

school?  Yes  No

If yes, please explain:

Have you ever been arrested?  Yes  No

If yes, please explain:

Last grade Completed in School

Attended College  Yes  No

Graduated from College  Yes  No

Father

Date of Birth _/ _/ _

Last grade Completed in School

Attended College  Yes  No

Graduated from College  Yes  No

Name of Guardian (if different from above) _

First MI Last Date of Birth _/ _/ _

Last grade Completed in School

Attended College  Yes  No

Graduated from College  Yes  No

Student Lives with (please check all that apply)

 Mother  Stepmother  Grandmother  Guardian

 Father  Stepfather Grandfather Foster parents

Other

Please list the people living in the home other than the student applicant:

Completed _ _ _

Other Siblings living outside the home:

Name Age Relationship Currently Last Grade

Attending Completed School

_ Brother Sister  Yes  No

_ Brother Sister  Yes  No

_ Brother Sister  Yes  No

_ Brother Sister  Yes  No

_ Brother Sister  Yes  No

_ Brother Sister  Yes  No

Special Circumstances: Are there any other special circumstances that you would

like to share with us about your situation such as: living arrangements, income, family history, etc.?

High School Information

Does your family plan to move next year?  Yes  No

If Yes: When? Where? _

What school do you plan on attending in 9 th grade?

Extracurricular Information

Please provide a complete list of your clubs, activities, interests, strengths, hobbies,

or awards you have received at school, church, and community Also any work experiences you may have Please print your information and attach a separate sheet of paper if additional space is needed for your answers

Student Statements

Each question must be answered, and answers must be handwritten by the student Write as much detail as possible Use additional paper if necessary

1 Why do you want to be in this program?

2 Why do you want to go to college?

3 What is your favorite subject? Why?

4 What do you like to do in your free time?

5 What person do you admire the most?

6 What is the most difficult situation you have ever faced? How did you handle it?

S ECTION 2: P ARENT /G UARDIAN I NFORMATION

Personal Information

Parent/Guardian 1 Parent/Guardian 2

Number of Years with Current

I NCOME I NFORMATION

What is your total annual (yearly) household income (include all household

members)?

$

Are you eligible for any Federal Assistance Programs? (Circle all that apply)

SNAP/Food Stamps TANF Medicaid SSI or SSA Other: _

If yes, please list the type of service and the amount received per month (attach

proof of service[s] to application):

Do you receive/are you supposed to receive child support or alimony?  Yes  No

If yes, how much per month (attach proof of support to application)? $ _

Do you pay child support?  Yes  No Do you pay alimony?  Yes  No

If yes, how much per month (attach proof of payment to application)? $ _

Family Statements

Please print your answers Write as much detail as possible If necessary, use additional paper

Explain the importance of your student receiving this scholarship:

How will your student being part of this program affect your family?

How does your family plan to help your student pursue their college education?

Student Responsibilities Contract

In order to be a Montgomery County Ohio College Promise scholar, who will earn

a college scholarship and be provided a mentor, every student must sign the

following contract and pledge to:

 Be Alcohol, Tobacco and Drug Free

 Be Crime Free

 Practice Good Citizenship

 Maintain a strong record of school attendance at a Montgomery County High School

 Participate in school co-curricular or extra-curricular activities and /or

community/faith based activities

 Come to the weekly meetings with their assigned mentor

 Attend any at-large programs or activities sponsored by the Montgomery County Ohio College Promise Program

 Attain a High School Diploma with a Grade Point Average (GPA) and test scores high enough to meet the entrance requirements of Central State

University, Denison University, Kettering College, Miami University,

Miami University Regionals, Ohio Northern University, Ohio University, Sinclair College, University of Dayton, Wittenberg University, Wright State University, Xavier University, or other 4-year university partners

Bottom Line: Montgomery County Ohio College Promise students are

respectful and responsible!

_

Student Signature

_

Date

Parents/Guardians Responsibilities Contract

Parent(s)/Guardian(s) must also make a commitment to their child’s success as a Montgomery County Ohio College Promise scholar Every parent/guardian must sign the following contact and pledge to:

 Provide a supportive environment at home that will contribute to the success

Bottom line: Montgomery County College Promise parents/guardians are involved and engaged, which will have a direct impact on the academic

success of their child/guardian!

I understand that the information contained in this application is truthful and

accurate and will be shared with the Montgomery County Ohio College Promise program staff and the selection committee I also certify that my child meets the program income requirements I also understand that any false information in this

application will result in my child being dismissed from the program

_

Parent/Guardian Signature

_

Date

Montgomery County Ohio College Promise Teacher Recommendation Form

Teacher Statement for Student: _

(Please provide student’s full name)

Please comment on this student’s attitude, behavior, and motivation in school Include the student’s ability to maintain at a minimum a 2.5 grade point average and their ability to succeed in post-secondary education Also feel free to provide any information regarding the student’s family situation that the Selection

Committee should be aware of

Feel free to call the MCOCP program office at 937-225-9922 or 937-225-9957 with any questions that you may have

You may return this to our offices as an email attachment Please send to

Jennifer Guanciale: jguanciale@mcocp.org

Montgomery County Ohio College Promise

Committee should be aware of

Feel free to call the MCOCP program office at 937-225-9922 or 937-225-9957 with any questions that you may have

You may return this to our offices as an email attachment Please send to Jennifer Guanciale: jguanciale@mcocp.org

Student’s last name

Montgomery County Ohio College Promise

Employment Verification Form

Note to parents/guardians: This form has to be completed for all adults over the age of 18 who live in the same household The form is to be signed by the

employer

Dear Employer,

This form is part of an application process for the Montgomery County Ohio

College Promise program The Montgomery County Ohio College Promise

program selects deserving students in the 8th grade, and upon the successful

completion of high school and the fulfillment of both a student and parent pledge, awards scholarships for attendance at Central State University, Denison University, Kettering College, Miami University, Miami University Regionals, Ohio Northern University, Ohio University, Sinclair College, University of Dayton, Wittenberg University, Wright State University, Xavier University, or other 4-year university partners

Please take a moment to complete this form in order for your employee’s child to

be considered

Employee Name _

Title/Position

Length of Employment

Salaried Employee Yes No

If yes, annual salary: $

If no, hourly rate: $ _

Typical number of weekly hours; _

Are there opportunities to receive overtime? Yes No